Discharge Planning in Emergency Department for Frail Older With AHF

F. Javier Martin Sanchez1,260 enrolled

Overview

Objectives: To demonstrate the efficacy of care transition holistic intervention (Multilevel Guided Discharge Planning, MGDP) in reducing 30-day adverse outcomes among frail older patients with acute heart failure (AHF) discharged from Emergency Departments (EDs) and to validate the results of MGDP in real life. Method: Investigators will select frail patients ≥70 years with primary diagnosis of AHF discharged from EDs. The intervention will consist of MGDP implementation: 1) checklist that includes clinical recommendations and resources activations; 2) scheduling of early visit with the specialist; 3) communication with primary care; 4) providing a written instruction sheet to patient or caregiver. Phase 1: matched-pair cluster randomized clinical trial. EDs were randomly allocated to intervention (n = 10) or control (n = 10) group. Investigators will compare the outcomes between intervention and control groups. Phase 2: a quasi-experimental study. The 20 EDs will carry out the intervention. Investigators will compare the outcomes between phase 1 and phase 2 of intervention group and between phase 1 and phase 2 of control group. The main outcome is a 30-day composite endpoint (ED revisit or hospital admission for AHF and cardiovascular death) after being discharged.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

1,260

Conditions

Acute Heart Failure Frail Elderly Syndrome

Eligibility

Sex: ALLMin age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥70 years. * Diagnosis of descompensated chronic heart failure. * Screening for frailty positive (ISAR ≥ 2). * Planned discharge home from Emergency Department (included observation and short stay unit). * Written informed consent provided by the patient or proxy. Exclusion Criteria: * De novo (new onset) acute heart failure (AHF). * Severe episode of acute heart failure (≥9th decile of MEESSI-AHF Score). * Uncorrected clinically significant primary valvular disease. * Acute coronary syndrome currently or within 30 days prior to enrolment. * Surgery or implanted device within 30 days prior to enrolment. * Significant arrhythmias. * Uncorrected systolic blood pressure \< 100 mmHg, O2 saturation baseline \< 92%, heart rate \< 60 or \>110 bpm, serum sodium \< 130 mmol/l, serum potassium \>5,5 mmol/l or hemoglobin \<9 g/dL prior to enrolment. * Planned treatment with vasoactive therapies, ventricular assist device, heart surgery or transplant within 6 months. * End stage renal disease. * Severe disability. * Difficulty intervention due to significant dementia, active delirium or psychiatric disorder. * Condition with a life expectancy \<1 year. * Length of stay in Emergency Department ≥96 hours. * Discharged to facility care. * Inability of outpatient follow-up.

Outcomes

Primary Outcomes

30-day emergency revisit or hospital admission for acute heart failure or cardiovascular mortality rate after discharge

The proportion of patients who have emergency revisit or hospital admission for acute heart failure or cardiovascular mortality within 30 days after discharge